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General NPI Number Information
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NPI Number | 1407031453
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Entity Type | Individual
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Provider Name | SHAMARA MONIQUE LONG RN
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Gender | Female
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 760 W. MOUNTAIN VIEW ST.
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City | ALTA DENA
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State | CA
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Zip | 91001
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Country | US
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Telephone | 626-798-6793
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Fax |
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Provider Business Mailing Address
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Address Line | 760 W. MOUNTAIN VIEW ST.
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City | ALTA DENA
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State | CA
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Zip | 91001
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Country | US
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Telephone | 517-879-3209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN 230989
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 95395942
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License Number State | CA
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